Weight Loss

In the nursing home setting, significant weight loss is defined as loss of 5% or more in the last 30 days or 10% or more in the last 180 days. Much weight loss can be prevented in the nursing home with proper care.

What are risk factors for weight loss?

  • Required assistance to eat or drink
  • Choking/swallowing problem
  • Refusals of food and fluids
  • Decreased meal consumption
  • Visual impairments
  • Poor condition of teeth that may cause pain with eating and problems chewing
  • Poor fitting dentures
  • Dementia/delirium
  • Depression
  • Chronic pain
  • Constipation
  • Medication side effects and interactions
  • Infections
  • Swallowing difficulties
  • Taste alterations
  • Smells of urine and stool in the nursing home

What can the nursing home do to reverse weight loss?

  • Encourage foods based on resident’s likes and dislikes
  • Request order for nutritional supplements that are calorie dense
  • Schedule weekly weights
  • Encourage a relaxed mealtime where intake is not rushed
  • Request dietitian consultation
  • Initiate intake and output monitoring (if not eating, probably not drinking, and some weight loss may be due to fluid loss)
  • Evaluate and document all meal consumption
  • Update the care plan with new nursing interventions
  • Request a dental evaluation, if necessary to treat poor condition of teeth or dentures, which may resolve chewing difficulties
  • Request social services to consult if depression is a likely cause
  • If medication side effects are a likely cause, consult with the physician or consultant pharmacist

Questions you can ask the nursing home regarding weight loss:

  • How does the nursing home determine the cause of weight loss in residents?
  • How flexible is the nursing home in tailoring meals and foods to individual preferences?
  • Does the nursing home have a program to rapidly and correctly notice change in nutrition?
  • How does the nursing home address issues that may affect the eating environment?

Resources

Evaluating and Treating Unintentional Weight Loss in the Elderly

Department of Health and Human Services – Emerging Practices in Nursing Homes

Comprehensive Multidisciplinary Assessment of the Demented Nursing Home Resident with Weight Loss